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Between 2007 and 2010, the Netherlands experienced an unprecedented outbreak of Q fever of more than 4000 human cases. Q fever infections of dairy goats, leading to abortion waves, were considered to be the cause of this outbreak. Measures to combat the outbreak had to be taken based on limited scientific knowledge and were aimed at the interruption of the infection cycle. Next to a notification obligation, hygienic and manure measures were made obligatory. A voluntary vaccination programme started in 2008 in the risk region and was made compulsory and extended to the whole country in the years thereafter. Unexpectedly, the implemented measures did not lead to the desired result and the number of patients increased instead of decreased in the second year of the epidemic. The measures were not effective, and the scientific knowledge was still limited and did not provide the necessary answers in 2008. To curb the epidemic, the control had to change from a risk-based approach to the precautionary principle which finally, during the lambing season of 2009/2010, led to the culling of more than 50,000 pregnant goats from infected herds. After taking this drastic measure, on top of the hygiene measures and compulsory vaccination of all dairy goats in the country, the number of patients decreased to the pre-outbreak level and in 2012 the epidemic could be declared ended. [ABSTRACT FROM PUBLISHER]

Purpose:The precautionary principle (PP) urges actions to prevent harm even in the face of scientific uncertainty. Members of Toronto Public Health (TPH) sought guidance on applying precaution. Methods: We searched five bibliographic databases (yield 60 articles from 1996 to 2009 and 8 from 2009 to 2011) and Google (yield 11 gray literature sources) for material relevant to local public health. From these sources, we extracted questions until saturation was reached (n=55). We applied these questions retrospectively to eight case studies where TPH felt precaution was applied. We ranked questions for their importance in applying precaution. Results: Our final guide included 35 questions in five domains: context, assessment, alternative interventions, implementation, and monitoring and evaluation. Importance rankings varied across cases, but the role of stakeholders in driving precautionary action was consistent. Monitoring and evaluation components could have been strengthened across cases. Conclusion: The TPH guide can assist municipal environmental health practitioners in applying precaution in a more transparent manner. [ABSTRACT FROM AUTHOR]

The article discusses the consequences of technological innovations. It explores the main concerns related to emerging technologies, one is their potential threats to human health, safety, and environment and another is their possible harmful application to moral interests. It examines the critical context of extreme uncertainty in technological revolution and the importance of precautionary measures. It notes the need for regulators to implement a precautionary reasoning called the Principle of Rational Precautionary Reason (PRPR).

The purpose of this article is to differentiate between the different functions of pharmaceutical risk communication and make explicit their different legal natures and implications. Risk communication has been generally categorised as a warning act, which is performed in order to prevent or minimise risk. Risk analysis has also drawn attention to the role played by information in reducing uncertainty about risk. Both approaches focus on the safety aspects of communication and its role in harm reduction. However, there are cases where a risk cannot be avoided or uncertainty reduced, for example the side effects associated with pharmaceutical products or when a decision about drug approval or withdrawal has to be made on the basis of available evidence. In these instances, risk communication has other purposes than preventing risk or reducing uncertainty. This article analyses the legal instruments which have been developed to control and manage the risks related to drugs (such as the notion of 'development risk' or 'residual risk') and relates them to different kinds of uncertainty. These are conceptualised as epistemic, ecological, metric, ethical and stochastic, depending on their nature. By referring to this taxonomy, different functions of pharmaceutical risk communication are identified and connected with the legal tools of uncertainty management. [ABSTRACT FROM AUTHOR]

A screening level human health risk assessment (HHRA) was applied to evaluate the human health implications of consuming selenium found in fish tissues collected downstream of coal mines in southeastern British Columbia, Canada. The study evaluated the potential for adverse human health effects associated with selenium, and considered known and potential benefits of selenium and fish ingestion. The results indicated that risks of selenosis due to consumption of selenium-contaminated fish in the region are negligible. Conclusions were strengthened by consideration of the potential benefits of selenium to human health, including: selenium essentiality for maintenance of good health; potential cancer prevention properties due to its role as an antioxidant; potential benefits for cardiovascular health; and other positive health benefits. The findings indicated that some aspects of the traditional framework for HHRA (e.g., application of safety factors to "err on the side of safety") are inappropriate for the assessment of selenium-contaminated fish. Due to both deficiency and toxicity in the selenium dose-response relationship, application of compounding conservatism in risk assessment may lead to recommended intakes of fish that are contrary to the public health interest. The need for balancing risk types, for incorporating positive responses in risk assessments, and the linkage to the precautionary principle, are discussed. [ABSTRACT FROM AUTHOR]

Early risk detection is essential for being able to address the most important environmental health risk-topics in a persistent and prospective manner. In support of the action programme “Environment and Health” (APUG) of the German Federal Ministry of Health and Social Security (BMGS) and the Federal Ministry for the Environment, Nature Conservation, and Nuclear Safety (BMU) which recommended that a detection and evaluation system for the timely recognition of emerging risk problems be developed, a qualitative feasibility study was commissioned. The results of this study are presented here and support the development of an early risk detection system based on the insights gained from the investigation of case studies and the differentiation and presentation of a risk typology, methods, tools, and suggested organizational processes. The study has shown that early risk detection includes the identification, characterization, evaluation and dissemination of information on possible risks as well as the circumstances of appearance and distribution. The goal is the recognition of possible risks in order for risk management to be able to introduce swift and appropriate measures. Consequently, it can also serve as an instrument towards further development of a balanced and structured implementation of the precautionary principle in the environmental health policy. [ABSTRACT FROM AUTHOR]

As technology advances rapidly, so do applications with potential adverse implications on human health. The possible threats include risks that can be substantial, far-reaching and irreversible, and currently available methods of investigation, designed to deal with direct exposure-disease associations, are not always suitable. Growing interest is being paid to health effects that may be the consequence of distal, “upstream” determinants. Considering the complex chain of events that links such determinants with health can be extremely difficult, and exposes severe limitations in science. Thus, there is often a mismatch between what is known and what would be required to inform rational, evidence-based decision making, which is increasingly called for. It has become apparent how production and use of scientific evidence in decision making must be accompanied by precaution, especially in those circumstances, more and more common in recent times, where there is an uncertain possibility that serious health consequences might take place. Several cautionary approaches have been proposed, but the Precautionary Principle (PP) has been the object of especially intense debate in recent years. Developed in the field of environmental health, the PP has been clarified, and has been applied or called for in several instances in public health. Although a unique definition is not available, the principle has been characterised, and criteria for its application have been proposed. However, many questions remain open on general as well as specific issues. In this paper, we address some of the questions that are relevant for the PP to support rational decision making in environment and health and more in general to strengthen its contribution towards human health protection. [ABSTRACT FROM AUTHOR]

The greater the potential for disastrous, large-scale, or catastrophic impacts on health, the greater the case for precaution. The imperative for precautionary action, critical also for downstream determinants of health, is at least as compelling where macro-level concerns about the sustainability of life on Earth are at issue. In this context, I propose that a higher threshold of uncertainty is needed where large-scale harms to health and well-being are possible. Initial efforts must focus on the training of researchers and risk managers for competencies in complexity, and in systems approaches to transdisciplinary enquiry. Revisiting the intent behind Bradford Hill on causation is an essential first step. Focus on the more proximate causes of diseases, such as those related either to occupational exposures or to more downstream environmental exposures, is left to others in this collection. [ABSTRACT FROM AUTHOR]

The precautionary principle, a recommendation to consider action to avoid a possible harm even if it is not certain to occur, is variously defined and interpreted. We present a range of definitions with an emphasis on their requirements for strength of evidence of harm and for actions to be taken. We describe the variety of approaches that have been adopted in developing policy to address the issue of possible health effects of electric and magnetic fields (EMF) in the face of scientific uncertainty. Further, we discuss specific aspects of scientific uncertainty regarding EMF health risks particularly relevant to the development of precautionary principle policy. We define and discuss prudent avoidance and other unique features of applications of the precautionary principle to EMF. We conclude with examples from EMF policy decisions of risk tradeoffs that need to be considered in developing any precautionary principle policy, and provide recommendations for better ways to define and implement the precautionary principle. [ABSTRACT FROM AUTHOR]

The article discussed implications of the Precautionary Principle (PP) for public health practice and research. The overall aim of the PP is to provide an approach to acting in the face of uncertainty. Like a single definition of the PP will probably not suffice, the various procedural aspects of the PP are currently being explored and discussed. This aspect is of particular interest at our conference. There is a need for an in-depth analysis of the role of the PP within the greater realm of decision-making in environmental health.